Your adult patient is experiencing lightheadedness and shortness of breath. He is found to be bradycardic with a second-degree type II AV heart block on the electrocardiogram. His heart rate is 44, he is breathing 20 times per minute, and has a blood pressure of 90 systolic. He is cool and pale but denies chest pain. Which of the following would be most appropriate if the patient fails to respond to atropine?

Correct Answer: C

Rationale: The correct answer is C: Transcutaneous pacing. In a patient with second-degree type II AV heart block and hemodynamic instability, transcutaneous pacing is the most appropriate intervention. This is because it directly stimulates the heart to maintain an adequate heart rate when other measures like atropine have failed. Synchronized cardioversion (choice B) is not indicated for bradycardia. Epinephrine (choice A) may worsen the AV block and increase the risk of ventricular arrhythmias. Administering a large IV bolus of normal saline (choice D) may not address the underlying conduction abnormality and could potentially worsen the patient's condition. Transcutaneous pacing is the most effective intervention to stabilize the patient's heart rate and improve perfusion in this scenario.

Correct Answer: B

Rationale: The correct answer is B: "Prevent secondary brain injury." In a patient with severe head injury (GCS 6), preventing secondary brain injury is crucial. This involves maintaining adequate cerebral perfusion pressure, controlling intracranial pressure, optimizing oxygenation, and avoiding factors that can exacerbate brain injury. Administering an osmotic diuretic (choice A) may help reduce intracranial pressure but does not address the overall goal of preventing secondary brain injury. Aggressively treating systemic hypertension (choice C) may lead to decreased cerebral perfusion and worsen the injury. Reducing metabolic requirements of the brain (choice D) is important but not the primary goal in this acute phase.

Correct Answer: B

Rationale: Rationale for Correct Answer (B): 1. Aspiration of bone marrow confirms appropriate positioning of the needle: This statement is true because when the needle is correctly placed within the bone marrow cavity, aspiration of bone marrow confirms proper positioning and ensures that the infusion will be successful. Summary of Incorrect Choices: A: Only crystalloid solutions may be safely infused through the needle - Incorrect, as both crystalloid and colloid solutions can be infused through the intraosseous route. C: Intraosseous infusion is the preferred route for volume resuscitation in small children - Incorrect, as while it is commonly used in pediatric emergencies, it may not always be the preferred route depending on the situation. D: Intraosseous infusion may be utilized indefinitely - Incorrect, as intraosseous infusion is typically considered a temporary measure and is not meant for long-term use.

Correct Answer: A

Rationale: The correct answer is A: "Moist heat" for treating frostbite. Moist heat helps to slowly rewarm the affected area, promoting blood flow and preventing further tissue damage. It is recommended to soak the frostbitten area in warm water (not hot) for about 20-30 minutes until normal color and sensation return. Choice B: Early amputation is incorrect as it is an extreme measure and should only be considered as a last resort when there is no other option to save the limb. Choice C: Padding and elevation can help reduce swelling and pain, but it is not the primary treatment for frostbite. Choice D: Vasodilators and heparin are not recommended for treating frostbite as they may increase the risk of complications. It is crucial to prioritize rewarming the affected area with moist heat for proper treatment.

Correct Answer: C

Rationale: The correct answer is C: Chest x-ray. In this scenario, the patient is at risk for thoracic injuries due to the motor vehicle crash and the need for mechanical ventilation. A chest x-ray is essential to assess for potential life-threatening conditions such as pneumothorax, hemothorax, or pulmonary contusions. This information is crucial for the safe transfer of the patient to another facility. A: FAST exam is typically used to assess for intra-abdominal bleeding and is not mandatory in this case. B: Lateral cervical spine x-ray is not necessary as the patient is already in full spinal protection and needs definitive neurosurgical care, not initial evaluation. D: Administration of methylprednisolone is not mandatory at this stage and should be based on specific guidelines for spinal cord injury management.